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Individual
WAYNE A MORTENSEN
Active
Individual
WAYNE A MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D4220
ID
1223G0001X
General Practice Dentistry
Primary
D-4220
ID
Other
Enumeration date
06/22/2009
Last updated
12/10/2018
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